Provider Reimbursement Auditor

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Oklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development. Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.Position Purpose: Perform comprehensive audits of provider claims to source documents and identify mis-payments.

• Conduct quality audits of provider claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
• Analyze errors and determine root causes for appropriate classification
• Utilize audit software to provide written documentation regarding audit observations
• Analyze and review responses to audit observations and facilitate corrective action plans
• Assist with providing updates to audit criteriaEducation/Experience: Associate's degree in related field or equivalent experience. 2+ years of medical or pharmacy claims processing or claims pricing experience. Microsoft Office applications, Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts preferred. Knowledge of CPT/HCPCS Coding preferred.Pay Range: $21.93 - $37.30 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.